Background: Direct observation of hand hygiene compliance is the gold standard for assessing and the basis for promoting hand hygiene. However, it is resource-consuming and provides but a momentary snapshot of performance. We sought to determine the role of hand disinfectant consumption as a surrogate marker for hand hygiene compliance.
Methods: Starting in 2007, we observed hand hygiene compliance in select departments of a tertiary care hospital in Switzerland once each year. Indications for hand disinfection followed national recommendations which are in accordance with the „five moments for hand hygiene" propagated by WHO in 2009. We calculated hand hygiene compliance as the rate of performed disinfections per observed indications. Information on hand disinfectant consumption was drawn from departmental orders with our hospital pharmacy.
Results: We collected hand hygiene compliance data from 2007 to 2014, with an average of 2'064 observed indications per year (95% confidence interval 1'785 – 2'341). The mean observed compliance rate was 0.71 (0.64 – 0.78) and increased over time from 0.62 (2007) to 0.77 (2014), p=0.002 (regression analysis). On average, 13'679 liters per year (11'009 – 16'349L) of hand disinfectant were used in the observed departments. There was a significant correlation between volume of disinfectant used for hand rubs and hand hygiene compliance, both in regression analysis (p=0.045) and by Spearman rank test (p=0.007) (cf. figure). Patient-days were not adjusted for as their number did not change substantially over the observation period.
Conclusion: Hand disinfectant consumption was correlated with the directly observed hand hygiene compliance over a span of eight years. Fluctuations of disinfectant ordering may provide additional information on trends in hand hygiene compliance aside from direct observations.
Figure: Correlation between handrub consumption with hand hygiene compliance, including annual number of observed indications (dark circles).
D. Nydegger, None
A. Eichenberger, None
R. Sommerstein, None
J. Marschall, Astellas Switzerland: Scientific Advisor , Consulting fee